Mesenteric venous thrombosis - A diagnosis not to be missed!

Mesenteric venous thrombosis (MVT), an uncommon but important clinical enti ty, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptom s. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with va gue abdominal symptoms. Diagnosis was made on the basis of computed tomogra phy of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagula ble state, myeloproliferative disorder, or malignancy. These cases illustra te well the nonspecific clinical presentation of MVT. A high index of suspi cion, recognition of known risk factors, or a previous history of venous th rombosis coupled with a history of nonspecific abdominal symptoms should al ert clinicians to the possibility of MVT. Early diagnosis and prompt antico agulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.